U.S. patent number 11,228,235 [Application Number 15/751,694] was granted by the patent office on 2022-01-18 for adjustable locking surgical retractor.
This patent grant is currently assigned to BOARD OF REGENTS, THE UNIVERSITY OF TEXAS SYSTEM. The grantee listed for this patent is Ramon F. Cestero, Justin Alexander Long. Invention is credited to Ramon F. Cestero, Justin Alexander Long.
United States Patent |
11,228,235 |
Cestero , et al. |
January 18, 2022 |
Adjustable locking surgical retractor
Abstract
A surgical retractor assembly for providing surgical exposure.
The surgical retractor assembly consists of multiple ring segments
connected by adjustable ratchet mechanisms to form a complete ring.
The ratchet mechanisms are attached to tissue retractor blades
which provide exposure of the wound when expanded, without the
requirement of a direct connection/attachment to an operating
table. The tissue retractor blades are attached in a manner which
is adjustable and facilitates the ability of the overall surgical
retractor assembly (ring segments and connectors) to be raised or
lowered with respect to the patient. The ring segments also allow
attachments of additional retractor blades or other surgical
retractor accessories for additional surgical exposure.
Inventors: |
Cestero; Ramon F. (San Antonio,
TX), Long; Justin Alexander (San Antonio, TX) |
Applicant: |
Name |
City |
State |
Country |
Type |
Cestero; Ramon F.
Long; Justin Alexander |
San Antonio
San Antonio |
TX
TX |
US
US |
|
|
Assignee: |
BOARD OF REGENTS, THE UNIVERSITY OF
TEXAS SYSTEM (Austin, TX)
|
Family
ID: |
1000006056364 |
Appl.
No.: |
15/751,694 |
Filed: |
August 10, 2016 |
PCT
Filed: |
August 10, 2016 |
PCT No.: |
PCT/US2016/046432 |
371(c)(1),(2),(4) Date: |
February 09, 2018 |
PCT
Pub. No.: |
WO2013/009968 |
PCT
Pub. Date: |
January 17, 2013 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20180234009 A1 |
Aug 16, 2018 |
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Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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62203269 |
Aug 10, 2015 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
90/50 (20160201); H03K 17/08 (20130101); B60R
16/033 (20130101); A61B 17/0206 (20130101); H02M
1/32 (20130101); A61B 17/0293 (20130101); H02M
3/04 (20130101); A61B 17/3439 (20130101); A61B
2017/00407 (20130101); A61B 1/32 (20130101); A61B
17/0218 (20130101); H02M 1/44 (20130101); A61B
17/3462 (20130101) |
Current International
Class: |
A61B
90/50 (20160101); B60R 16/033 (20060101); A61B
17/34 (20060101); H03K 17/08 (20060101); A61B
17/02 (20060101); H02M 1/32 (20070101); A61B
1/32 (20060101); A61B 17/00 (20060101); H02M
1/44 (20070101); H02M 3/04 (20060101) |
Field of
Search: |
;600/233,231,201,208,210,211,235,215,213,216,219,221,222 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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201939399 |
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Aug 2011 |
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CN |
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203815511 |
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Sep 2014 |
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CN |
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202014003736 |
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May 2014 |
|
DE |
|
H04- 4500014 |
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Jan 1992 |
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JP |
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H10-033543 |
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Feb 1998 |
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JP |
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WO 01/80725 |
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Nov 2001 |
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WO |
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WO 2010/100592 |
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Sep 2010 |
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WO |
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Other References
Office Action and Search Report Issued in Corresponding Chinese
Patent Application No. 2016800469810, dated Oct. 22, 2019. English
Translation. cited by applicant .
Extended European Search Report Issued in European Application No.
16835867.9, dated Mar. 11, 2019. cited by applicant .
International Preliminary Report on Patentability issued in
Application No. PCT/US2016/046432, dated Feb. 22, 2018. cited by
applicant .
International Search Report and Written Opinion issued in
Application No. PCT/US2016/046432, dated Dec. 26, 2016. cited by
applicant .
Office Action Issued in Corresponding Japanese Patent Application
No. 2018527842, dated Aug. 26, 2020. cited by applicant.
|
Primary Examiner: Shirsat; Marcela I.
Parent Case Text
This application is a national phase application under 35 U.S.C.
.sctn. 371 of International Application No. PCT/US2016/046432,
filed Aug. 10, 2016, which claims priority to U.S. Provisional
Patent Application Ser. No. 62/203,269 filed Aug. 10, 2015, each of
which is incorporated herein by reference in its entirety.
Claims
What is claimed is:
1. An adjustable surgical retractor comprising, a retractor frame
having an adjustable perimeter comprising: a plurality of frame
segments, each frame segment having a long axis and a plurality of
arm portions, the plurality of arm portions comprising a first
straight arm portion and a second straight arm portion, and a curve
portion extending between the first straight arm portion and the
second straight arm portion, where the long axis of the frame
segment bends at the curve portion to form an angle between the
first straight arm portion and the second straight arm portion,
each frame segment having a top and bottom face with an inner edge
and an outer edge, each frame segment forming a series of notches
or teeth extending continuously along the curve portion between the
first straight arm portion and the second straight arm portion, the
curve portion being configured to receive at least one of a
plurality of retractor blades at any point along the curve portion,
and a plurality of connectors, each connector being configured to
receive a straight arm portion of each of two adjacent frame
segments when the straight arm portions are parallel to form at
least a portion of the retractor frame, wherein each connector can
be in (i) an unlocked configuration that allows movement of the
received arm portions of the adjacent frame segments with respect
to one another, thereby allowing the retractor frame to expand or
contract by adjustment of a perimeter of the retractor frame or
(ii) a locked configuration that restricts the movement of the
received arm-portions of the adjacent frame segments with respect
to one another, thereby restricting at least one of expansion and
contraction of the retractor frame; and the plurality of retractor
blades coupled to the retractor frame where the coupling of at
least one the plurality of retractor blades engages the series of
notches or teeth along the curve portion.
2. The retractor of claim 1, wherein the frame segments each
further comprise an expansion stop at one end of the frame segment
that is configured to stop expansion of the retractor frame prior
to a frame segment passing completely out of the connector.
3. The retractor of claim 1, wherein at least one of the arm
portions further comprises a removable expansion stop coupled with
a prescribed slot or pattern of holes formed in the frame segment
that together are configured to stop expansion of the retractor
frame prior to the frame segment passing completely out of a
connector.
4. The retractor of claim 1, wherein at least one of the connectors
when in the locked configuration does not allow the retractor frame
to be expanded or contracted.
5. The retractor of claim 1, wherein at least one of the connectors
is configured to position the ends of the adjacent frame segments
in a stacked configuration.
6. The retractor of claim 1, wherein at least one of the connectors
is configured to position the ends of the adjacent frame segments
in an offset configuration.
7. The retractor of claim 1, wherein the retractor frame is a
rounded polygon.
8. The retractor of claim 1, wherein the retractor frame is a
rounded quadrilateral.
9. The retractor of claim 1, wherein the arm portions of adjacent
frame segments are positioned having the inner edge of one straight
arm portion aligned parallel to the outer end of an adjacent frame
segment.
10. The retractor of claim 1, wherein the arm portions are 10 to 30
centimeters in length.
11. The retractor of claim 1, wherein the angle between the first
straight arm portion and the second straight arm portion is
approximately 90 degrees.
12. The retractor of claim 1, wherein the plurality of retractor
blades comprise 2, 3, or 4 retractor blades are coupled to the
retractor frame.
13. The retractor of claim 1, wherein the plurality of retractor
blades comprise 2, 3, or 4 retractor blades are configured to be
decoupled from the retractor frame.
14. The retractor of claim 1, wherein at least one retractor blade
is coupled to a connector.
15. The retractor of claim 1, wherein at least one retractor blade
is coupled to the frame segment at one of the plurality of arm
portions.
16. The retractor of claim 15, wherein at least one retractor blade
is configured to be moveable along the curve portion of each frame
segment.
17. The retractor of claim 1, wherein the retractor is coupled to a
bed frame.
18. The retractor of claim 1, wherein the retractor frame is
configured to be attached to patient solely by the plurality of
retractor blades after being expanded.
19. A method of using the surgical retractor of claim 1,
comprising: coupling a plurality of retractor blades on the frame
of the retractor, at least one of the blades being coupled to the
curve portion of a frame segment of the frame; inserting the
retractor blades of the retractor of claim 1 in a wound or incision
of a patient body; and expanding the surgical retractor in one or
more superior, inferior, or lateral direction to engage the
retractor blades with the patient body and expose a body cavity;
and locking the connectors so as to prevent contraction of the
frame.
20. The retractor of claim 1 the plurality of frame segments being
four segments.
21. An adjustable surgical retractor comprising, a retractor frame
having an adjustable perimeter comprising: a plurality of frame
segments, each frame segment having a long axis and a plurality of
arm portions, the plurality of arm portions comprising a first
straight arm portion and a second straight arm portion, and a curve
portion extending between the first straight arm portion and the
second straight arm portion, where the long axis of the frame
segment bends at the curve portion to form an angle between the
first straight arm portion and the second straight arm portion,
each frame segment having a top and bottom face with an inner edge
and an outer edge; and a plurality of connectors, each connector
being configured to receive at least one of the plurality of arm
portions of two adjacent frame segments to form the retractor
frame, wherein each connector can be in (i) an unlocked
configuration that allows movement of the received arm portions of
the adjacent frame segments with respect to one another, thereby
allowing the retractor frame to expand or contract by adjustment of
a perimeter of the retractor frame or (ii) a locked configuration
that restricts the movement of the received arm-portions of the
adjacent frame segments with respect to one another, thereby
restricting at least one of expansion and contraction of the
retractor frame; and a plurality of retractor blades, each of the
plurality of retractor blades being coupled to the retractor frame
by one of said plurality of connectors, wherein the face of each of
the plurality of retractor blades is perpendicular to and below a
plane of the retractor frame; each of the plurality of retractor
blades being adjustably coupled to a connector among the plurality
of connectors, said connector being configured to translatably
receive a proximal portion of a retractor blade coupled thereto and
to reversably fix a position of said retractor blade with a locking
mechanism incorporated into said connector, wherein the proximal
portion of said retractor blade is translatable in said connector
so as to move said retractor blade up and down until locked by a
retractor blade locking mechanism.
22. A surgical retractor frame segment comprising: a plurality of
arm portions, the plurality of arm portions comprising a first
straight arm portion and a second straight arm portion and a curve
portion there between where the long axis of the frame segment
bends to form an angle between the two arm portions, the frame
segment having a top and bottom face with an inner edge and an
outer edge, the outer edge of each frame segment forming a series
of notches or teeth extending continuously along the curve portion
between the first straight arm portion and the second straight arm
portion, the curve portion being configured to receive at least one
of a plurality of retractor blades at any point along the curve
portion; and a connector coupled to a straight arm portion of the
plurality of arm portions, the connector being configured to
receive, when placed in parallel with the arm portion to which the
connector is coupled, an arm portion of a separate surgical
retractor frame segment, wherein the connector can be in (i) an
unlocked configuration that allows movement of the received arm
portion with respect to the arm portion to which the connector is
coupled, or (ii) a locked configuration that restricts the movement
of the received arm portion with respect to the arm portion to
which the connector is coupled.
23. The frame segment of claim 22, further comprising an expansion
stop that can be reversibly connected to the frame segment at or
near one or both ends of the frame segment.
24. An adjustable surgical retractor comprising, a retractor frame
having an adjustable perimeter comprising: a plurality of frame
segments, each frame segment having a long axis and a plurality of
arm portions, the plurality of arm portions comprising a first
straight arm portion and a second straight arm portion, and a curve
portion extending between the first straight arm portion and the
second straight arm portion, where the long axis of the frame
segment bends at the curve portion to form an angle between the
first straight arm portion and the second straight arm portion,
each frame segment having a top and bottom face with an inner edge
and an outer edge; the plurality of frame segments being four frame
segments; and a plurality of connectors, each connector being
configured to receive at least one of the plurality of arm portions
of two adjacent frame segments to form the retractor frame, wherein
each connector can be in (i) an unlocked configuration that allows
movement of the received arm portions of the adjacent frame
segments with respect to one another, thereby allowing the
retractor frame to expand or contract by adjustment of a perimeter
of the retractor frame or (ii) a locked configuration that
restricts the movement of the received arm portions of the adjacent
frame segments with respect to one another, thereby restricting at
least one of expansion and contraction of the retractor frame; and
a plurality of retractor blades coupled to the retractor frame,
wherein a face of each of said plurality of retractor blades is
perpendicular to the plane of the retractor frame.
25. The retractor of claim 24, wherein at least one of the arm
portions further comprises a removable expansion stop coupled with
a prescribed slot or pattern of holes formed in the frame segment
that together are configured to stop expansion of the frame prior
to the frame segment passing completely out of a connector.
26. The retractor of claim 24, wherein at least one of the
connectors when in the locked configuration does not allow the
retractor frame to be expanded or contracted.
27. The retractor of claim 24, wherein at least one of the
connectors is configured to position the ends of the adjacent frame
segments in a stacked configuration.
28. The retractor of claim 24, wherein at least one of the
connectors is configured to position the ends of the adjacent frame
segments in an offset configuration.
29. The retractor of claim 24, wherein the retractor blades are
adjustable and each connector is configured to translatably receive
a proximal portion of the retractor blade and to reversibly fix the
retractor blade position with a locking mechanism incorporated into
the connector, wherein the proximal portion of the retractor blade
is translatable in the connector until locked by a retractor blade
locking mechanism.
30. The retractor of claim 24, wherein the retractor frame is a
rounded polygon.
31. The retractor of claim 24, wherein the retractor frame is a
rounded quadrilateral.
32. The retractor of claim 24, wherein the outer edge of the frame
segment forms the series of notches or teeth.
33. The retractor of claim 24, wherein the arm portions of adjacent
frame segments are positioned having the inner edge of one straight
arm portion aligned substantially parallel to the outer end of an
adjacent frame segment.
34. The retractor of claim 24, wherein the arm portions are 10 to
30 centimeters in length.
35. The retractor of claim 24, wherein the angle between the first
straight arm portion and the second straight arm portion is
approximately 90 degrees.
36. The retractor of claim 24, wherein the plurality of retractor
blades comprise 2, 3, or 4 retractor blades are coupled to the
retractor frame.
37. The retractor of claim 24, wherein the plurality of retractor
blades comprise 2, 3, or 4 retractor blades are configured to
decouple from the retractor frame.
38. The retractor of claim 24, wherein at least one retractor blade
is coupled to a connector.
39. The retractor of claim 24, wherein at least one retractor blade
is coupled to the frame segment at one of the plurality of arm
portions.
40. The retractor of claim 24, wherein at least one retractor blade
is configured to be moveable along the curve portion of each frame
segment.
41. The retractor of claim 24, wherein the retractor is coupled to
a bed frame.
42. The retractor of claim 24, wherein the retractor frame is
configured to be attached to patient solely by the plurality of
retractor blades after being expanded.
Description
BACKGROUND
Abdominal operations in both emergency and elective surgery
settings require adequate exposure of abdominal contents in order
for the surgeon to properly visualize areas of injury or disease.
This is typically accomplished by the use of static metal
retractors. Two of the most common retractor mechanisms in current
use are the Balfour retractor and the Bookwalter retractor. Each of
these retractors presents advantages and disadvantages in their
design and use. The Balfour retractor consists of a frame with
integrated metal blades on a ratchet system which, when engaged,
retracts the abdominal wall laterally, thereby exposing the
abdominal contents and allowing the surgeon to operate. The
Bookwalter mechanism consists of a supporting frame attached to the
operating table upon which a rigid non-adjustable metal ring is
attached to which retractor blades are then attached individually.
Despite the ubiquitous use of these retractors, these surgical
retractor mechanisms have not been improved upon for considerable
time.
The Balfour retractor is perhaps the most commonly utilized
abdominal retractor due its simple design, ease of use, and rapid
exposure of the abdomen, particularly in trauma and emergency
surgery settings when time is of the essence. Since it does not
require the attachment of a metal frame to the operating room bed,
as with the Bookwalter retractor, valuable time is not wasted and
it can be quickly inserted after the abdominal incision is
created.
Despite the Balfour retractor's prevalence in operating rooms and
ease of utilization, there are several limitations to its use. It
provides inadequate abdominal exposure of large or obese patients.
In larger or obese patients, the current design of the standard
Balfour retractor often does not provide enough retraction to
adequately expose the abdomen. The frame along which the retractor
blades run is typically too short for larger or obese patients,
resulting in suboptimal exposure and frequently necessitating
conversion to another retractor system. Due to the Balfour
retractor's inherently limited design, the surgical incision is
only retracted along one axis (transverse), limiting overall
exposure of the wound. An optional additional retractor blade
(bladder blade) can be attached which only adds retraction in the
inferior direction, typically resulting in suboptimal exposure
requiring conversion to another retractor system.
The standard Balfour retractor does not provide an additional frame
upon which to attach additional retractor blades except for a
single bladder blade. This significantly limits the ability to
retract additional incisional or abdominal contents compared to
other retractor mechanisms, thereby limiting surgical exposure.
Additionally, the Balfour retractor system commonly poses a
significant problem during its use due to the unintentional
movement and migration of the retractor blades along the edges of
the surgical wound. The two retractor blades which provide lateral
traction on the wound edges (or abdominal wall in abdominal
operations) frequently unintentionally migrate to either the
superior or inferior parts of the wound, causing rotation of the
entire retractor mechanism, loss of wound edge retraction, and
requiring either time-consuming repositioning of the retractor or
conversion to another type of retractor system. This is
particularly common in large or obese patients.
The Bookwalter retractor is typically the retractor system used
when the Balfour retractor system is considered inadequate or
ineffective. It consists of a supporting metal rod which is
attached to a side rail on the operating room table by a
non-sterile individual in the operating room after the patient is
under anesthesia (the rail on the operating table is not considered
part of the sterile operating field). A second metal arm is then
attached to this supporting rod, and a rigid circular or oblong
metal ring is then attached to the second metal arm. Once this is
in place, individual retractor blades can then be attached, using
the rigid ring for support.
Despite the popularity of the Bookwalter retractor it also presents
several limitations. The Bookwalter retractor mechanism involves
fixation to the operating room table which requires attachment by a
non-sterile individual in the operating room. Occasionally this
causes concerns in maintenance of the sterile field, as the surgeon
may need to place his hands below the sterile barrier in order to
assist and properly place the retractor arm. In addition, the
multiple arms which require setup before surgical retraction is
achieved mandates a significant amount of time in instrument setup,
rendering this system inadequate for emergency settings or
operations when time is of the essence. The circumferential ring
used in the Bookwalter system is not expandable and frequently
limits the placement of additional retractors in both the
longitudinal and transverse axes. In addition, the fixed sizes of
the rings do not allow adjustment of retraction depending on the
individual physical characteristics of each patient and various
types and sizes of wounds or incisions. The Bookwalter system also
requires frequent repositioning by the surgical team during its
use. After the Bookwalter system is set up and attached to the bed
frame, the ring system is thereby fixed in place and additional
retractors are attached. However, as the operation progresses and
surgical exposure requirements change, the system needs to be
repositioned to place the static non-expandable ring into the
correct location. This requires interruption of the operation,
removal of the retractor blades, repositioning of the ring, and
reattachment of the retractor blades, again requiring significant
time. There is an existing need for additional retractor
systems.
SUMMARY
Certain embodiments are directed to a surgical retractor with a
frame having an adjustable circumference comprising four
interconnecting frame segments. In certain aspects the outer edge
of the frame segment has a series of ridges forming teeth or
grooves along at least a portion of the length, and in certain
aspects along the entire length of the outer edge. The frame
segment can have a stop mechanism positioned at one or both ends of
the frame segment. The stop can be in the form of a screw, pin,
hole, or elevated material that can contact or engage a connector
to stop the movement of the frame segment through the connector
resulting in disassembly of the retractor. In certain aspects the
stop is a screw that can engage threads formed in the face of a
frame segment. In certain respects a surgical retractor comprises
(a) a retractor frame having an adjustable circumference comprising
(i) a plurality of curved frame segments, each frame segment
comprising a first and second substantially straight arm portion
and a curve portion there between where the long axis of the frame
segment bends to form a rounded angle, each frame segment having a
top and bottom face with an inner edge and an outer edge, wherein
the frame segments are configured to overlap with a first arm
portion of one frame segment overlapping a second arm portion of an
adjacent frame segment, and (ii) connectors configured to receive
arm portions of two adjacent frame segments to form the retractor
frame, wherein the connector can be in (i) an unlocked
configuration that allows the arm portions of the adjacent frame
segments to move with respect to one another allowing the
circumference of the frame to adjust or (ii) a locked configuration
that fixes an arm portion at a position relative to an arm portion
of the adjacent frame segment; and (b) two or more retractor blades
coupled to the frame where the face of the retractor blade is
substantially perpendicular to the plane of the frame. In certain
aspects the connectors are designed to provide a ratchet mechanism.
The ratchet mechanism of the connector is configured to interact
with ratchet teeth that are position along all or a portion of the
inner edge of the frame segments. In a further embodiment the
connectors are configured to provide a space between the frame
segments faces. The space between the frame segments can provide
for the insertion of a portion of an attachment (e.g., a lip or
protrusion on the attachment) to further stabilize additional
attachments that may be affixed to the retractor. The ratchet
mechanism allows the frame to be expanded when the connectors are
in the locked position but does not allow the contraction of the
frame. In certain aspects the ratchet mechanism associated with the
connectors is a directional ratchet that allows a frame segment to
move in one direction that results in expansion of the frame and
resists or does not allow movement of the frame segment in the
opposite direction, i.e., frame contraction. In a further aspect
the edges of the ratchet teeth are beveled to allow for clearance
of the ratchet. In certain aspects the retractor can be configured
to be stabilized, coupled, or fixed to a subjects body, a wound, an
incision, or a cavity. The retractor can be stabilized, coupled, or
fixed by a clamp, suture, staple, or other mechanism. In certain
aspects the retractor can have an adaptor or be fixed to an adaptor
that in turn can be fixed to a support, such as a bed or operating
table.
In another embodiment the connector is configured to allow the
adjustment of the retractor blades up and down with respect to the
frame segments. The connector can form a passage through which the
proximal portion of the retractor blade can pass through. The
passage being configured with a retractor blade locking mechanism
that reversibly fixes the retractor blade at a particular position
or depth. The locking mechanism can be a pin or a screw that can
reversibly engage the proximal portion of the retractor blade to
hold it in place when engaged and allow its movement when
disengaged. In certain aspects the pin or screw can pass through an
opening in the connector body or be attached to the top or bottom
of the connector body. The proximal portion of the retractor blade
can have an adjustment portion that passes through the connector.
The adjustment portion can have grooves, holes, or teeth to engage
the retractor blade locking mechanism.
In certain aspects the retractor frame is a rounded polygon, e.g.,
a triangle, quadrilateral (square, rectangle, rhombus, etc.),
pentagon, hexagon or polygon. In a further aspect the frame is a
rounded quadrilateral. In still a further aspect the frame is a
rounded rectangle.
In certain aspects the outer edge, inner edge, or outer edge and
inner edge of the frame segment is toothed along at least a portion
of the segment. In a further aspect the top face, bottom face, or
top and bottom face comprise a series of grooves or ridges.
In certain aspects the top, bottom, or top and bottom faces are
planar. In a further aspect the top, bottom, or top and bottom
faces are curved (concave or convex) along the short axis of the
segment.
In certain aspects the frame segments are about 20, 25, 30, 35, 40,
45, 50, 60, 65, 70, 75, or 80 centimeters in length, including all
values and ranges there between. In a further aspect a first arm
portion of a segment is about 10 to 40 centimeters in length and a
second arm portion is about 10 to 40 centimeters in length. In
certain aspects the first and second arm portions are of equal
length. The length of arm portion is measured from the end of the
segment to beginning of the curve portion of the segment. In
certain aspects the rounded angle of the frame segment is
approximately 90 degrees or less. In a further aspect the arm
portions of adjacent frame segments are positioned having the inner
edge of one substantially straight arm portion aligned
substantially parallel to the outer end of an adjacent frame
segment. In another aspect the top face of one segment can face the
bottom face of an adjacent segment. The frame segment faces can be
in contact with each other or form a gap or space between the frame
segments.
In certain aspects 2, 3, 4 or more retractor blades are coupled to
the retractor frame. The retractor blade can have a distal blade
portion and a proximal connector or adjustment portion. In a
further aspect at least 2 retractor blades are coupled to the
frame. In other aspects at least 4 retractor blades are coupled to
the frame. In still a further aspect at least one retractor blade
is coupled to a connector. In certain aspects at least one
retractor blade is coupled to a frame segment. In a further aspect
at least one retractor blade is configured to be moveable along the
retractor frame. In still a further aspect the retractor blade is
configured to be moveable up and down with respect to the retractor
frame.
Certain embodiments are directed to a surgical retractor frame
segment comprising a first and second substantially straight arm
portion and a curve portion there between where the long axis of
the frame segment bends to form an angle, each frame segment having
a top and bottom face with an inner edge and an outer edge. The
frame segment can further comprise an expansions stop that can be
reversibly connected to the top or bottom face of the frame segment
at or near one or both ends of the frame segment.
Other embodiments are directed to a surgical retractor connector
comprising a body forming two lumens, each lumen configured to
receive arm portions of two adjacent frame segments, a ratchet
mechanism configured to interact with the inner edge of the frame
segment when inserted into the connector lumen, wherein the
connector can be in (i) an unlocked configuration that allows the
arm portions of the adjacent frame segments to move with respect to
one another allowing the circumference of the frame to adjust or
(ii) a locked configuration that fixes an arm portion at a position
relative to an arm portion of the adjacent frame segment. The
connector can further comprise a retractor blade positioned below
the frame and perpendicular to the plane of the frame. The
retractor blade can be fixed to the connector body or removably
connected to the connector body.
Certain embodiments are directed to methods of using the surgical
retractor described herein, the method comprising: inserting a
contracted retractor of claim 1 in a wound or incision, expanding
the surgical retractor in one or more superior, inferior, or
lateral direction to expose a body cavity, and locking the
frame.
Other embodiments of the invention are discussed throughout this
application. Any embodiment discussed with respect to one aspect of
the invention applies to other aspects of the invention as well and
vice versa. Each embodiment described herein is understood to be
embodiments of the invention that are applicable to all aspects of
the invention. It is contemplated that any embodiment discussed
herein can be implemented with respect to any method or composition
of the invention, and vice versa. Furthermore, compositions and
kits of the invention can be used to achieve methods of the
invention.
The use of the word "a" or "an" when used in conjunction with the
term "comprising" in the claims and/or the specification may mean
"one," but it is also consistent with the meaning of "one or more,"
"at least one," and "one or more than one."
Throughout this application, the term "about" is used to indicate
that a value includes the standard deviation of error for the
device or method being employed to determine the value.
The use of the term "or" in the claims is used to mean "and/or"
unless explicitly indicated to refer to alternatives only or the
alternatives are mutually exclusive, although the disclosure
supports a definition that refers to only alternatives and
"and/or."
As used in this specification and claim(s), the words "comprising"
(and any form of comprising, such as "comprise" and "comprises"),
"having" (and any form of having, such as "have" and "has"),
"including" (and any form of including, such as "includes" and
"include") or "containing" (and any form of containing, such as
"contains" and "contain") are inclusive or open-ended and do not
exclude additional, unrecited elements or method steps.
Other objects, features and advantages of the present invention
will become apparent from the following detailed description. It
should be understood, however, that the detailed description and
the specific examples, while indicating specific embodiments of the
invention, are given by way of illustration only, since various
changes and modifications within the spirit and scope of the
invention will become apparent to those skilled in the art from
this detailed description.
DESCRIPTION OF THE DRAWINGS
The following drawings form part of the present specification and
are included to further demonstrate certain aspects of the present
invention. The invention may be better understood by reference to
one or more of these drawings in combination with the detailed
description of the specification embodiments presented herein.
FIG. 1A is a perspective illustration of one embodiment of an
adjustable retractor assembly in a collapsed configuration.
FIG. 1B is a top-down illustration of a second embodiment of an
adjustable retractor assembly in a collapsed configuration.
FIG. 1C is a perspective illustration from the top of the second
embodiment of an adjustable retractor assembly in a collapsed
configuration.
FIG. 1D is a perspective illustration from the bottom of the second
embodiment of an adjustable retractor assembly in a collapsed
configuration.
FIG. 1E is a side illustration of a second embodiment of an
adjustable retractor assembly in a collapsed configuration.
FIG. 2A is a perspective illustration of one embodiment of an
adjustable retractor assembly in an expanded configuration.
FIG. 2B is a perspective illustration of a second embodiment of an
adjustable retractor assembly in an expanded configuration.
FIG. 2C is a top-down illustration of the second embodiment of an
adjustable retractor assembly in an expanded configuration.
FIG. 3A is a perspective illustration of one embodiment of an
extended retractor.
FIG. 3B is a perspective illustration of a second embodiment of an
extended retractor
FIG. 3C is a perspective view from the bottom of a second
embodiment of an extended retractor.
FIG. 3D is a side view illustration of a second embodiment of an
extended retractor
FIG. 4 is an illustration of one embodiment of a connector.
FIG. 5 is an illustration of a frame segment.
FIG. 6A is an illustration of one embodiment for a
segment/connector assembly.
FIG. 6B is an illustration of a second embodiment for a
segment/connector assembly.
FIG. 7 is an exploded view of one embodiment of the surgical
retractor.
DESCRIPTION
Attachment of the retractor described herein to an operating table
or other support is not necessary, but can be an option, and
therefore use of the retractor described herein does not require
involvement of any non-sterile member of the operating team. In
addition, the lack of an obtrusive fixed metal frame allows the
surgeon increased mobility and positioning at the sides of the
patient during the operation. The system remains sterile, and its
simple and rapid deployment can be applied to emergency and time
sensitive situations.
The adjustable/expandable system comprising multiple segments
expanded on connectors or locking ratchet mechanisms allows full
exposure of the surgical wound, as the multiple ratchet mechanisms
attached to the ring segments allow the wound to be maximally
retracted in both the transverse and longitudinal axes. This design
allows the incision to be retracted to its maximal possible
dimensions, as it is not limited by the use of a pre-determined
ring size (as in the Bookwalter retractor). In addition, retraction
of the wound edges in multiple directions (as opposed to only the
transverse axis with the Balfour retractor) better engages the
abdominal wall, allows for greater tension against the abdominal
wall, and provides better stabilization of the retractor mechanism
thereby improving surgical exposure. Lastly, the improved wound
exposure obtained with retraction in multiple axes may reduce the
necessary size of the incision required to obtain the same degree
of exposure, thereby reducing scarring and unnecessary trauma to
the tissues.
In addition to allowing maximal retraction of the incision in not
only the transverse but also the longitudinal axes, the expandable
locking circumferential frame system allows the subsequent
attachment of multiple retractor blades to provide additional
surgical exposure (similar to the Bookwalter retractor). The frame
also allows the use of lighting options which attach directly to
the frame, improving surgical visualization and illumination of
deep wounds and/or spaces.
The surgical retractor comprises multiple frame segments forming a
retractor frame by connecting adjacent segments with a connector.
In certain aspects the retractor comprises four segments joined by
four connectors. In certain embodiments a segment will have two arm
portions joined by a curved portion. The segments are configured to
be assembled to form a rounded polygon frame. In certain aspects
the frame assembly can be a triangle, square, rectangle, pentagon,
or other regular polygon. In certain embodiments the frame is a
rounded rectangle, square, rhombus or irregular quadrilateral,
which can depend on how each segment is positioned with respect to
the adjacent segment. Each segment comprises a top and bottom
surface/face with an inner edge facing the inside of the assembled
frame and an outer facing outward.
FIGS. 1A-1E shows certain embodiments of an assembled retractor
frame in a retracted or collapsed configuration. In certain
embodiments the frame comprises four frame segments 100. Each
segment 100 has two ends 101 and 102 connected by a connecting
segment 103 (see also FIG. 5). The segments can have teeth 104
along one or more edges, and/or ridges or grooves along one or more
face. In certain aspects the inner edge of segment 100 is
configured to interact with a ratchet mechanism (112 and 113),
portions of segment 100 can have ratchet teeth 105. The inner edge
faces the interior of the opening formed by assembly of segments
100. In other aspects segment 100 can have notches, grooves, or
teeth 104 that can be utilized for securing attachments and the
like. In certain aspects notches, grooves, or teeth can be
positioned in the outer edge of segment 100, the upper face of
segment 100, the lower face of segment 100, or combinations
thereof. Segment ends 101 and 102 can be connected by connector
106. In certain embodiments connector 106 comprises a ratchet
mechanism that interacts with ratchet teeth 105 to adjustably
secure segment ends 101 and 102 and allowing expansion and
contraction of the assembled frame as well as stabilizing the frame
once a desired configuration is achieved. In certain aspects
connector 106 can have a fixed or removable retractor blade 107. In
certain aspects the frame segment 100 has an expansion stop 117.
The expansion stop can be a screw, a clip, a pin, or other
mechanism that is configured to not allow the frame segment to pass
through connector 106.
Referring to FIGS. 1B to 1D show an embodiment of the invention
where the retractor blades can be moved up and down with respect to
the frame. In this embodiment the connector is configured to
provide for movement of retractor blade 107. Connector 106 is
configured to receive the proximal portion of the retractor blade
114. The proximal portion of the retractor blade 114 is reversibly
locked by using retractor blade locking mechanism 115. The proximal
portion of the retractor can form a retractor blade locking
mechanism receiver 116. The locking mechanism receiver 116 can be a
notch, a hole, a cavity or other structure to receive the locking
mechanism 115. When the locking mechanism is engaged the retractor
blade is reversibly fixed at that particular position. If one
wanted to adjust the retractor blade one would disengage locking
mechanism 115, move the retractor blade 107 to a new position, and
fix that position by engaging locking mechanism 115 with the
locking mechanism receiver 116.
FIG. 2A-2C and FIG. 3A-3D show an assembled retractor frame in an
expanded configuration. Connector 106, 206, 306 are configured with
a release/locking mechanism that allows a person to release segment
100, 200, 300 and allow expansion or contraction of the frame as
well as providing a locking mechanism to secure the segments in
place when desired. In certain aspects connectors 106, 206, 306
comprise a locking, ratchet mechanism (see also FIG. 4 and FIG. 6).
In another embodiment the frame segment has a stop mechanism that
will stop the expansion of the frame at a certain point. The
expansion stop 217, 317 is an elevated portion that cannot pass
through the connector resulting the stopping of the frame expansion
at the point to the expansion stop 21,317. Expansion stop 217, 317
can be a screw or a pin that can be engaged or disengaged as
needed. Typically the expansion stop would be engaged during use to
prevent over extension. FIG. 2B-2C and
FIG. 3B-3C show an embodiment where not only does the frame have a
mechanism for adjustment, but so does the retractor blade portion
of the device. The retractor blade can have a portion that is
proximal to the frame (proximal portion 214, 314) that passes
through next to the connector and can engage a retractor blade
locking mechanism 215, 315 to be reversibly fixed in position.
Reversibly fixed means that it will maintain its position until a
locking mechanism is disengaged or the engagement is reversed
allowing freedom of movement when disengaged. In certain aspects
the proximal portion can have one or more locking mechanism
receivers 216, 316 which receive the locking mechanism.
FIG. 4 shows one embodiment of connector 106, 206, 306 in
isolation. Each connector 106, 206, 306 can have two receiving
openings, a top opening 410 and a bottom opening 411 for receiving
the ends of two adjacent segments, e.g., 101 and 102. In certain
aspects opening 410 and 411 can be offset, stacked, or
side-by-side. In certain aspects the openings are offset. In other
aspects the openings are stacked. In certain aspects a connector
has 1 (e.g., when a connector is a fixed, integral part of one end
of a frame segment), 2, or more openings. In certain embodiments
one frame segment is attached to two consecutive connectors, for
example, when the connector has 2 openings, a first frame segment
is attached to a first opening in a first connector and a first
opening in a second connector, the second connector can be attached
to an adjacent frame segment. The adjacent frame segment is
attached through the second opening in a shared connector (second
connector) and a second opening of the non-shared connector (third
connector) and so forth until a retractor is formed. Connector 406
can comprise ratchets 412 and 413, which are configured to ratchet
in opposite directions. Ratchets 412 and 413 can be configured to
interact with a toothed surface of two adjacent segments (e.g., see
FIG. 5 part 505). The ratchets can be configured to allow the frame
to be expanded by applying a force away from the centerpoint of the
retractor without disengaging the ratchet. In other aspects the
ratchet is configured to not allow contraction of the frame unless
the ratchet is disengaged. Other release/locking mechanisms can be
integrated into the current design, so the ratchet mechanism is
just one example. The position of the connector along a segment can
be fixed by engaging a lock mechanism that can engage the teeth or
grooves for locking purposes. In other embodiments the connector
can be integrated into one end of the frame segment, in this case
the connector may only have one opening and one ratchet mechanism
since the connector is fixed at one end of the segment. A retractor
blade need not be associated with the connector. A retractor blade
or other implement can be fixed to one or more connector or can be
an accessory implement that attaches to the frame at positions
other than the connector points. A plurality of retractor blades or
other implements can be attached to the frame, in certain aspects
2, 3, 4, 5, 6, 7, 8, 9, 10 or more retractor blades and/or other
implements can be attached to the frame. The only limiting factor
for attachment is the space available along the frame and physical
interference between attachments.
FIG. 5 shows an illustration of a frame segment in isolation. Frame
segment 500 comprises various regions or portions. Frame segment
500 has first end 501 and second end 502. Each end of frame segment
500 is configured to interact with a connector in a way that allows
assembly and adjustment of the assembled frame of the retractor.
The inner edge of the ends can be configured to allow connector
release/locking. In certain aspects the outer edge can be
configured to interact with the connector, alone or in combination
with the inner edge. Connecting segment 503 is the portion of the
frame segment between end 501 and 502. Connecting segment 503
provides for angle to be formed between the ends and allow a
plurality of frame segments to be positioned with respect to each
other in order to form a closed retractor frame with each segment
being connected by a connector. In certain aspects connecting
segment 503 is in the form of a curve or an angle. The connecting
segment can be characterized by the angle formed between the long
axis of end 501 and 502 (segment angle). In certain aspects this
segment angle is between 45 and 180 degrees. In certain aspects the
segment angle is or is about 90 degrees.
FIGS. 6A and 6B illustrate embodiments of a connector assembly
connecting two adjacent frame segments. In FIG. 6A, this particular
embodiment shows frame segments 600 being positioned in opening in
connector 606. Connector 606 being configured with ratchet 612 and
613. Each frame segment 600 has ratchet teeth 605 being angle in
opposing directions with respect to the long axis of the frame
segment ends. The ratchet mechanism can be disengaged by pressing
the ratchet at the end opposite the ratchet, pivoting the ratchet
away from contacting the ratchet teeth and allowing movement of the
frame segment in either direction. FIG. 6B illustrates an
embodiment where the retractor blade can be adjusted using the
adjusting mechanism incorporated into connector 606 and the
proximal portion of the retractor blade 614.
FIG. 7 illustrated an exploded view of the surgical retractor.
Shown are frame segments 700 having a first end 701 and a second
end 702 connected by a curved portion 703. The outer edge of
segment 700 having grooves 704 and the inner edge having ratchet
teeth 705. Also shown are connector 706, ratchet arm 712 and 713,
expansion stop 717, retractor blade 707, retractor blade arm 714
with receiving mechanisms 714, retractor blade locking mechanism
715.
The segment, connector, and retractor blade can be metallic,
metallic alloy, plastic, or combination thereof. In certain aspects
the retractor is made of material that can be autoclaved or
otherwise sterilized (e.g. irradiated, etc.). The frame segment can
be a formed rod (having a bend or angle) with circular, oval,
square, or rectangular cross section. The connectors are configured
to receive and reversibly engage the frame segments and connecting
adjacent segments in the frame. The segments are coupled connectors
to form a retractor frame. Each connector couples two segments.
* * * * *